[Show abstract][Hide abstract] ABSTRACT: Objective:
To overview and evaluate the main findings, methodological shortcomings, and time trends of the recent psychiatric epidemiology studies in Turkey, as well as to provide areas prone for development in forthcoming research.
PubMed and Turkish Psychiatry Index were screened to identify relevant studies. Any epidemiological study from 2000 to 2012 with a general population or unique sub-population sample was included. Papers and results were classified as depression, anxiety, psychotic, dissociative, conversion, personality, alcohol and substance abuse, and trauma-related disorders, and common geriatric disorders.
There are various epidemiological studies on various psychiatric disorders in Turkey. However, there are main shortcomings and trends in research that subsequently stagnate current psychiatric epidemiological research. First, epidemiological studies were mainly conducted for academic purposes, not for addressing epidemiological issues or issues of health policy. Second, studies mainly focused on particular fields and institutions, which led to non-systematic accumulation of epidemiological results. Third, although Turkey is a natural laboratory of social conflicts and disasters, there were few studies with a focus on probable outcomes. Fourth, high-quality epidemiological studies with disseminating results tended to decrease, even in common mental disorders such as depression. Fifth, there were very few epidemiological studies using contemporary designs such as follow-up, genetic, or biomarker data in the general-population.
Although psychiatric epidemiological studies of the last decade provide a suitable ground for future challenges, current trends in this research area has tended to stagnate, despite the potential for unique contributions. Forthcoming studies and researchers may notice novel methodological developments in epidemiology, with a growing attention on rapid urbanization, natural disasters, social conflicts, and migration.
Turk psikiyatri dergisi = Turkish journal of psychiatry 12/2014; 25(4). DOI:10.5080/u7463 · 0.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Different methods are used to understand the suicidal mind. Suicide note analysis may be most direct way to do this.
To study the content of suicide letters under forensic evaluation in terms of psychological and cognitive aspects.
A total of 51 letters were referred to The Council of Forensic Medicine from different cities of Turkey and analyzed by a research group with ten members including forensic medicine specialists and psychiatrists. The Questionnaire of Content Analysis of Suicide Letters (The Q-CAS), developed by researchers, was used to analyze the cognitive and cultural themes of suicide letters. The cognitive distortions about the self, the world, and the future as well as cultural phenomena were evaluated including sociodemographic features.
Financial problems in males and relationship problems in females were the most frequent life events related to suicide. Hopelessness, weakness, loneliness--in decreasing order--were the most predominant cognitions and emotions. The total score of females were higher than that of males (p=.002).
These negative cognitions should be taken into consideration when therapeutic interventions are planned on individuals with suicidal thoughts.
Crisis The Journal of Crisis Intervention and Suicide Prevention 02/2012; 33(2):73-9. DOI:10.1027/0227-5910/a000112 · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It has been suggested that the treatment strategy needs to be reviewed and changed if depression occurs in patients with posttraumatic stress disorder (PTSD). We analyzed data extracted from the Marmara Epidemiological Survey (MES) which had examined 683 survivors at 3 years after a devastating earthquake. Fifty three cases (40.5%) out of the 131 cases with PTSD had also been diagnosed with MDD. Comorbid PTSD and MDD group has significantly lower rates of recovery from PTSD in comparison to PTSD without MDD (26.4% vs. 47.4% respectively). Rates of past psychiatric disorder and past traumatic experience were significantly more frequent among the comorbid group. Moreover, comorbidity of PTSD and MDD was clearly associated with greater psychological distress, more severe PTSD, and diminished perceived social support. Past psychiatric disorder, General Health Questionnaire (GHQ-12) and Multidimensional Scale of Perceived Social Scale (MSPSS) total scores succeeded in predicting the comorbidity of PTSD and MDD significantly.
Community Mental Health Journal 11/2010; 48(2):161-6. DOI:10.1007/s10597-010-9359-4 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence of Criterion A traumatic events and current posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in prisoners in Kocaeli Closed Prison.
The study was conducted in Kocaeli Closed Prison in Turkey. The sample consisted of 30 female and 30 male prisoners who had been in prison for at least 1 month. The PTSD and MDD section of the Structured Clinical Interview for DSM-IV and the Traumatic Events Screening Instrument for Adults were used by experienced clinicians.
Most (n = 52, 86.7%) participants reported lifetime exposure to at least 1 Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PTSD Criterion A event. Although the August 17, 1999, earthquake was the most prevalent traumatic event (n = 31, 51.7%), it was not related to the risk of current PTSD in prisoners. Current PTSD was rare among men (n = 2, 6.7%) and women (n = 3, 10%) but more prevalent than in community surveys of adults. Traumatic events that were relatively unique to the incarcerated population (e.g., committing murder) were identified. Moreover, 17% of women (n = 5) and men (n = 5) were diagnosed with MDD. Traumatic events that had the strongest conditional probabilities of association with a diagnosis of PTSD and MDD were identified.
Exposure to traumatic stressors was highly prevalent among prisoners. Ongoing interpersonal traumatic events were particularly likely to be experienced as traumatic and related to PTSD and MDD, and violent criminal acts may be highly traumatic for the perpetrator.
[Show abstract][Hide abstract] ABSTRACT: Some studies have found elevated alexithymia among patients with chronic pain, but the correlations between alexithymia and the severity of pain, depression, and anxiety among migraine patients are unclear. The aims of the present study were to investigate whether individuals suffering from episodic migraine (EM) differ from those with chronic migraine (CM) in regards to depression, anxiety, and alexithymia measures and to investigate the association of alexithymia with the results of depression and anxiety test inventories and illness characteristics.
A total of 165 subjects with EM and 135 subjects with CM were studied. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Toronto Alexithymia Scale (TAS) were administered to all subjects. The correlation between alexithymia and sociodemographic variables, family history of migraine and illness characteristics (pain severity, frequency of episode, duration of illness) were evaluated.
Compared with EM patients, the CM patients had significantly higher scores on measures of depression but not alexithymia and anxiety. There was a positive correlation between TAS scores and age and education in both migraine groups, but there was no correlation between TAS scores and other demographic variables. Depression and anxiety were significantly correlated with alexithymia in both migraine groups.
Our results indicate that CM patients are considerably more depressive than EM patients. In this study, depression and anxiety were significantly correlated with alexithymia in both migraine groups. Our results demonstrate a positive association between depression, anxiety, and alexithymia in migraine patients.
[Show abstract][Hide abstract] ABSTRACT: On 3 January 2008 explosives placed in an automobile on a thoroughfare in Diyarbakir, southeastern Turkey exploded in a terrorist attack. The aim of this study was to determine the risk factors for the diagnosis of and the rate of post-traumatic stress disorder (PTSD) among individuals who were eye- or earwitnesses to the explosion 1 and 3 months after the explosion.
Among the residents and workers in close proximity to the explosion site, 216 individuals who were eye- or earwitnesses to the explosion were included in the study. A sociodemographic data form and a traumatic stress symptom scale were administered to the participants 1 and 3 months following the explosion.
In all, 12.5% of the participants were diagnosed with PTSD 1 month post-explosion versus 9.6% 3 months post-explosion. While history of psychiatric disorder and physical injury were risk factors for PTSD 1 month post-explosion, risk factors 3 months post-explosion was history of psychiatric disorder.
PTSD occurs at high rates in individuals exposed to terrorist attacks. More studies following such events are required in Turkey. In light of these results it is advised that individuals at risk of PTSD receive therapeutic and preventive interventions provided by mental health professionals.
Turk psikiyatri dergisi = Turkish journal of psychiatry 02/2009; 20(2):118-26. · 0.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: The purpose of this study is to learn more about general practititoners' knowledge, attitudes and social distance towards depression which is the most prevalent mental disorder seen in general practice. Method: The survey was conducted in 2002 using face-to-face interviews in offices of 300 general practitioners in Turkey. Data were derived from the questionnaire developed for the survey called "Attitudes Towards Mental Disorders". Results: Almost all of the practitioners believed that depression was treatable, and it could be completely cured according to 90% of the respondents. 80% of the practitioners considered "extreme sadness", near half of them "weak personality" and more than 90% "social handicaps" to be as the causes of depression. 66% believed that these patients would not improve unless social problems were solved. Attitudes of the subjects with relatives diagnosed depression, married, and older were more positive than the others with respect to social distance characteristics. Discussion: Although general practitoners with closer social distance held more positive attitudes towards depression than community people, the results suggest that incorrect knowledge and beliefs about etiology, nonmedical treatment methods and risk of dependency have a tendency to persist in this group. The results of this study underline the need for development of new education programmes aimed to decrease effects of stigmatization based upon information obtained more studies about attitudes and beliefs of physicians.
[Show abstract][Hide abstract] ABSTRACT: Objective: Worldwide, cancer is the second most frequent cause of death after the ischemic heart disease. Lifetime prevalence of psychiatric co-morbidities in cancer patients is 30-40%. Major depression is the most prevalent psychiatric disorder in patients with cancer. Major depression has a negative effect on quality of life, self-care, treatment compliance, prognosis, and treatment response of the cancer patient. In this study, we evaluated the prevalence of major depression in patients with cancer and the related factors which might affect this co-morbidity. Methods: Hundred patients with cancer (53 men and 47 women) who attended to oncology outpatient units were recruited to the study. Participants were assessed with 'Structured Clinical Interview for DSM-IV (SCID) - Mood Disorders Module' and 'The Questionnaire for the Assessment of Patients with Cancer'. Results: The prevalence of major depression in patients with cancer was 22%. The prevalence of major depression was higher in women than in men. Insomnia was found in 50% of patients. Insomnia was recognized in 20% of patients with breast cancer and 15% of patients with lung cancer. Suicidal ideation was found in 11% of the patients with cancer. The prevalence of suicidal ideation increased with age and it decreased as the disease progressed. Conclusion: Major depression is a frequent psychiatric problem in the patients diagnosed with cancer. By reason of frequency, early recognition of major depression and the related factors will provide appropriate treatment. The frequency of suicidal ideation is even important in this population. Psychosocial support and psychiatric treatment approaches should be the focus of further attention in oncology clinics.
Anadolu Psikiyatri Dergisi 06/2008; 9(2):59-66. · 0.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine the prevalence of posttraumatic stress disorder (PTSD) in parents of children with cancer. Five questionnaires were administered to 104 parents, including a sociodemographic questionnaire, a traumatic events check list, the Structured Clinical Interview for DSM-IV PTSD and Major Depressive Disorder modules, and the self-rating instrument General Health Questionnaire-12. The prevalence of PTSD was 34.6%. The statistically significant tendency to develop PTSD were found in the female gender, better educational status, death of a loved one, previous history of psychiatric disorder, having a child with poorer prognosis, and the presence of radiotherapy in child's treatment. The vulnerable parents must receive psychosocial support.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to determine the prevalence of sexual dysfunction in patients with schizophrenia under antipsychotic therapy and to investigate the effect of various parameters on sexual dysfunction.
A total of 827 stabilized outpatients who met DSM-IV criteria for schizophrenia, were recruited in the study. Arizona Sexual Experience Scale (ASEX) and the subscale on sexual function of the UKU Side Effects Rating Scale were applied at a single interview.
In total, 52.6% of the patients had sexual dysfunction, 54.2% reported a low sexual desire and 41.7% reported problems in having an orgasm. Erectile dysfunction and ejaculation problems were seen in 48.1% and 64.2% of the men, respectively; amenorrhea was seen in 24.9% of the women. ASEX score and severity of disease were found to be correlated (p=0.02). Higher ASEX scores were observed in patients who smoked (p=0.01). Men receiving atypical monotherapy had lower ASEX scores than those receiving a combination of atypical and conventional antipsychotics (p=0.017). Patients on combination therapy had more ejaculation problems than the atypical group (p=0.001). Low sexual desire was more prevalent among women using conventional drugs than those on atypical drugs (p=0.004). In linear regression analyses, ASEX was affected significantly and independently by the severity of the disease only in men (p=0.005).
Our results show that sexual dysfunction is widespread among patients with schizophrenia on antipsychotic medications.
European Psychiatry 08/2007; 22(5):328-33. DOI:10.1016/j.eurpsy.2007.01.001 · 3.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of the study is to describe the community prevalence of psychiatric disorder, mainly posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD) 3 years after a devastating earthquake.
Three years after the Marmara Earthquake, 683 individuals from the epicentre were randomly selected to form a representative sample and were assessed with Composite International Diagnostic Interview (CIDI), General Health Questionnaire (GHQ), Traumatic Stress Symptom Checklist (TSSC) and Beck Depression Inventory (BDI).
The 36 months prevalence of PTSD and MDD after the Marmara Earthquake were 19.2% and 18.7% respectively. The current prevalence of PTSD and MDD in the affected community was found to be 11.7% and 10.5%, respectively. PTSD and MDD were the most prevalent disorders after the disaster and showed a decrease over time. However, only 38.9% of the PTSD cases identified at any time over the 3 years were in remission at the 3rd-year. The co-occurrence of MDD with PTSD resulted in a decrease in the rate of recovery from PTSD. MDD was also the most prevalent disorder accompanying PTSD. Of all the subjects 37.5% with PTSD still met the MDD criteria at the 3rd year postearthquake.
In comparison with the data from pre-earthquake national mental health profile, the present study showed that the prevalence of MDD, panic disorder, OCD, GAD, social phobia and special phobias were still higher in the affected region 3 years after the earthquake.
Social Psychiatry and Psychiatric Epidemiology 12/2006; 41(11):868-74. DOI:10.1007/s00127-006-0107-6 · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although antidepressant drugs have been proven as an effective treatment for posttraumatic stress disorder (PTSD), there are few comparative studies of antidepressants that are acting on different neurotransmitters. The main aim of this study is to compare the efficacy of different class of antidepressant drugs on the PTSD. SUBJECTS/MATERIALS AND METHODS: In this open label study, the patients who met DSM-IV criteria for PTSD were randomly assigned to flexible doses of fluoxetine, moclobemide, or tianeptine. After the first assessment, consecutive assessments were performed at the end of weeks 2, 4, 8, and 12 using clinician administered PTSD scale (CAPS) and Clinical Global Impression of Severity (CGI-S). Changes in the total score of CAPS and sub-scale scores of symptom clusters (re-experience, avoidance, and hyperarousal) were the main output of efficacy. All statistics were based on intention-to-treat and last-observation-carried-forward (LOCF) principles.
Thirty-eight patients were assigned to fluoxetine, 35 patients were assigned to moclobemide, and 30 patients were assigned to tianeptine group. Gender distributions and mean ages of the treatment groups were not significantly different. Drop-out rates due to an adverse events or unknown reasons were not significantly different among fluoxetine (18.4%), moclobemide (14.3%), and tianeptine (20.0%) groups. All three treatments has led to a significant improvement in PTSD severity assessed with CAPS total score (ANOVA P < 0.001). Similarly, total scores of re-experiencing, avoidance, and hyperarousal clusters that are subscales of CAPS were significantly reduced by all three treatments (with ANOVA all P values < 0.001). There was not significant difference in terms of treatment effect between three groups.
Treatment groups showed very similar improvement on all ratings scales. The findings support that fluoxetine, moclobemide, and tianeptine are all effective in the treatment of PTSD. Different mechanisms of action for these antidepressant drugs might result in the same common neurochemical end point. However, further studies using different classes of antidepressant drugs are needed.
European Psychiatry 05/2006; 21(3):174-9. DOI:10.1016/j.eurpsy.2005.03.007 · 3.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although attitudes towards psychiatric illness influence its presentation, detection, recognition, treatment adherence and rehabilitation, the lay public's opinions and beliefs about the treatment of depression have not been investigated sufficiently.
The aim of this study was to determine public opinions and beliefs about the treatment of depression and the influence of perception and causal attributions on attitudes towards treatment of depression in urban areas.
This study was carried out with a representative sample in Istanbul, which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of 32 items rating attitudes towards depression.
The public believes that psychological and social interventions are more effective than pharmacotherapy, and that the medicines used in treatment of depression are harmful and addictive. There was a general reluctance to consult a physician for depression, and psychiatrists were felt to be more helpful than general practitioners. The public viewed depression as treatable. A high educational level and perceiving depression as a disease is associated with positive beliefs and opinions about the treatment of depression; but the perception of depressive patients as aggressive is associated with negative beliefs and opinions about the treatment of depression.
The beliefs that "psychological and social interventions are more effective than pharmacotherapy" and "antidepressants are harmful and addictive" must specifically be taken into account in clinical practice and in anti-stigma campaigns. Additional studies are needed to understand the public's tendency to conceptualise depression as a psychosocial problem. In clinical practice, depression should be introduced as a bio-psychosocial disease whatever its cause: biological, psychological or social. In addition, the differences between extreme worry and disease, and the lack of aggressiveness of depressive patients, must be emphasised.
Social Psychiatry and Psychiatric Epidemiology 12/2005; 40(11):869-76. DOI:10.1007/s00127-005-0985-x · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine public attitudes towards patients with depression and the influence of perception and causal attributions on social distance towards individuals suffering from depression in urban areas.
This study was carried out with a representative sample in Istanbul which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of ten items screening the demographic features and health status of the participants, and 32 items rating attitudes towards depression.
The respondents' attitudes towards depression were very negative and nearly half of the subjects perceived people with depression as dangerous. More than half of the subjects stated that they would not marry a person with depression, and nearly half of the subjects stated that they would not rent their house to a person with depression. One-quarter of the subjects stated that depressive patients should not be free in the community. The subjects who considered depression as a disease and who believed that weakness of personality and social problems cause depression had negative attitudes towards depression.
In Istanbul, people recognise depression well, but their attitudes towards it are fairly negative. The urban public has unfavourable attitudes towards depression and a tendency to isolate patients from the society. Notwithstanding the high prevalence, there is still considerable stigmatisation associated with depression.
Social Psychiatry and Psychiatric Epidemiology 01/2005; 39(12):1010-6. DOI:10.1007/s00127-004-0843-4 · 2.54 Impact Factor